Online Bicycle Rental Booking Form
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*  
Bicycle Rental Details
Bikes (Hourly Rental):*  
Bikes (Daily Rental):*  
Bikes (Weekly Rental):*  
Helmet  
  Adult $5.00  
Helmet:  
  Child $3.00  
Grand Total:  
 
Date of Pickup:*  
Pickup Time:*  
Date of Return:*   mm/dd/yyyy
Return Time:*  
Billing Information
First Name:*   Same name as on your card
Middle Initial:  
Last Name:*  
Address Line 1:*   Where your statement is mailed
Address Line 2:   Apt. or Suite No.
City:*  
State:  
Province:  
Country:*  
Zip Code:*  
Phone:  
Credit/Debit Card Information
Card Number:*   No dashes or spaces please
Expiration Month:*   From your card
Expiration Year:*   From your card
Card Brand:*  

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